Introduction Remote electrocardiographic monitoring (“telemetry”) is a useful tool to identify life threatening arrhythmic complications in hospital inpatients. However, whilst appropriate use criteria (AUC) exist, the application of them is not universal, thus leading to potentially ineffective and inefficient use of this limited resource. We aimed to establish the current level of appropriate use of telemetry in hospital inpatients in our centre, and hypothesised that a new request card in addition to an educational program for requesting clinicians would help to improve adherence to published AUC.
Methods Prospective single centre quality improvement project in a 625-bed district general hospital, with approval from the local clinical governance committee. Initial data collection was performed over an 8 week period from March to May 2013, and included all patients for whom telemetry was requested for. Data collected included basic demographic and clinical information, the indication for telemetry, and the duration and results of the period of monitoring. The proposed indication was compared with the rating system documented in the American Heart Association 2004 consensus statement for remote electrocardiographic monitoring,1 and classed as level 1 (definitely indicated), level 2 (possibly indicated), or level 3 (not indicated). Following the initial data collection, the telemetry request form was redesigned to better reflect the AUC, and a series of seminars were held for junior clinicians on the use of telemetry at the same centre. The data collection was then repeated over another 8 week cycle from April to June 2015, and the results compared.
Results There were 48 patients (29 female) in cycle 1 and 51 patients (27 female) in cycle 2. Mean age was 73.6 ± 12.7 years in cycle 1 and 69.9 ± 17.8 years in cycle 2 (p = 0.231), and mean duration of recording was 3.58 ± 2.90 days in cycle 1 and 2.84 ± 1.93 days in cycle 2 (p = 0.439). The commonest indication in both data cycles was the identification of an electrolyte abnormality. Only one patient (in cycle 1) experienced a life threatening arrhythmia whilst on telemetry. In cycle 1 we identified that only 50% of requests were class 1, and this improved to 75% in cycle 2 (p = 0.042; Figure 1). Additionally there were fewer gaps in recording in cycle 2 (mean 7.1 ± 7.9 h versus 11.6 ± 10.2 h, p = 0.030).
Conclusions Whilst this is a single centre study with small numbers, we have shown that adherence to AUC for the use of telemetry in our hospital increased significantly following two simple, easy-to-implement, low cost initiatives. Sustaining such an improvement, and applying similar methods to improve the appropriate use of other investigations, merits further study.
Drew B, Califf R, Funk M, et al. Practice standards for electrocardiographic monitoring in hospital settings. Circ. 2004;110:2721-–46
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